The Aetna Life Insurance Company sells traditional and consumer-directed health care insurance plans and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans. It has the following openings available at its Blue Bell office:
Director, Health Plan Actuary
This position will lead/manage projects in support of strategic and operating plan goals. He/she will negotiate and influence sound business decisions by adhering to established risk management principles, and will anticipate and recognize matters that materially affect financial results and make sound, unbiased reports on these matters. The person will develop a high performing team, including having the responsibility for hiring and terminating.
The ideal candidate will possess a Bachelor’s Degree in mathematics, statistics, actuarial science, or a related field. He/she should have at least seven years of related work experience, along with previous management experience. Experience in Commercial pricing is preferred. The person must be an ASA or FSA and a member of the American Academy of Actuaries with the ability to sign state rate filings and other required actuarial certifications.
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This position will research and define the claim features for Aetna’s consumer business, and will configure claim adjudication provisions to support the many functions within the consumer business administrative platform. He/she reviews new and existing claim adjudication provisions and determines the most effective programming methodology, which facilitates accurate and consistent claim adjudication. The person will document decisions made during configuration to use as a reference for future claim adjudication builds, and will work collaboratively with internal/external constituents on quality reviews, audits, and test plan(s) execution.
The ideal candidate will possess a Bachelor’s Degree, and have three to five years of project management experience. He/she will have a proven track record of meeting project dates and deadlines. The person will be able to conduct GAP analysis and research Analysis, and create business requirements.
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Medicare Complaint Director
This position coordinates effective resolution of Medicare CTMs and effective escalation of potential broken processes, and identifies opportunities to improve service for members or providers across the Medicare business. He/she will direct the CTM activities for a Health Plan and/or line of business, and will ensure compliance with all Centers for Medicare and Medicaid Services (CMS) regulations. The person will act as primary liaison on CTM activities with all CMS regional offices.
The ideal candidate will possess a Bachelor’s Degree, and have seven to ten years of Medicare experience, including three to five years of supervisory or management experience. CMS with Medicare experience is highly desired. He/she must have knowledge of all types of managed care products, including HMO, PPO, and Medicare Part D.
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